Why the cancer moonshot is already off course

The cancer moonshot initiative raised skepticism because of the limited funding to end cancer. Unfortunately the recently announced panel membership confirms that while the project may launch, skewed representation may tilt the mission off course.

It is no surprise that the panel heavily tilts toward immunology, medical oncology, surgery and big science. But three core specialties you would find at any tumor board are missing: pathology, radiology, and radiation oncology. Pathologists are “the doctor’s doctor,” applying basic science to clinical medicine to establish the vast majority of cancer diagnoses. Radiologists provide images to help us establish cancer stage, interpret treatment effectiveness, and can use interventional approaches of minimally invasive therapy. Radiation oncologists treat over 50 percent of all cancer patients at some point during the cancer experience in the U.S., with increasingly targeted ways to cure and alleviate suffering. All could play key roles in ensuring targeted immunotherapy research is on the right course.

Any community cancer program, such as mine, would be deficient if these cancer specialists didn’t show up. Why should we feel differently in this case? Were these specialties excluded accidentally? I’m sure there are some excellent people in these fields to provide balance to the panel.

Speaking of community medicine, every single panelist is an academic or in industry. There will be a heavy bias toward researchers and big business. Where are the community doctors and cancer centers? We treat the majority of cancer patients. Any advances in cancer care should be able to help all Americans, not just those close to major academic medical centers. If the initiative has frugal funding, it’s essential to ensure the research funding is pragmatic, not just scientifically sound. A daily practitioner or two might curb some of the irrational enthusiasm and press to keep the project’s aim centered on its true goal: Helping cancer patients, everywhere.

Patients and caregivers deserve direct representation, too. People with the personal experience of the diseases targeted for progress. Increasingly, patients participate in hospital boards, scientific meetings, and clinical trial design. Yes, the science is important. But people without scientific or medical backgrounds can add value to the project. Why not include the people most affected by the disease and the financial toxicity of trying to pay for treatment?

Finally, we can’t measure success without the help of biostatisticians. Quality evidence from clinical trials requires rigorous design. At least one expert in data analysis deserves a position on the panel itself rather than being considered support staff.

The cancer moonshot may have launched, but it’s already taking off on a potentially unbalanced trajectory. Hopefully, the panel will get all necessary hands on deck before this latest mission to improve cancer care hits escape velocity rather than reaching its goal.